AHA pushes for risk-adjusted readmissions for race

Jun 8, 2011 2:04pm

The American Hospital Association (AHA) yesterday called on the Centers for Medicare & Medicaid (CMS) to include race and limited English proficiency to its risk-adjustment methodology for reimbursement. Currently, the Hospital Readmissions Reduction Program (HRRP) under the Patient Protection and Affordable Care Act rewards hospitals that reduce preventable readmission of their Medicare beneficiaries.

AHA urged CMS to consider other factors in its risk adjustment that may have been overlooked in a letter to CMS Administrator Donald M. Berwick, MD, MPP.

"The presumption underlying the program is that readmissions most commonly occur due to a hospital's inadequate care and follow-up. But there is another critical factor at play," states the letter.

AHA cited a Journal of the American Medical Association study in which black patients had a higher rate of readmissions. "[R]esearch from both the government and private sector shows that African-American patients in general have a higher risk of readmission and that hospitals serving disproportionately large numbers of minorities have higher readmission rates across the board. Given these facts, a hospital may end up being penalized under the HRRP simply for serving large numbers of minority patients rather than for actually providing poor quality care," the letter continued.

"Stated differently, the HRRP may disproportionately affect hospitals serving a large number of minorities. And, by penalizing these hospitals, the HRRP will in turn disproportionately harm minority patients."

AHA also says that legally the current CMS risk-adjustment methodology may violate Title VI of the Civil Rights Act of 1964, which states that no one be denied participation or benefits from federally funded programs based on race, color or national origin.